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Digestive Diseases and Sciences

, Volume 63, Issue 10, pp 2507–2518 | Cite as

Quality Improvement in Gastroenterology: A Systematic Review of Practical Interventions for Clinicians

  • Courtney Reynolds
  • Eric Esrailian
  • Daniel Hommes
Review
  • 163 Downloads

Abstract

Background

Quality improvement (QI) identifies practical methods to improve patient care; however, it is not always widely known which QI methods are successful. We sought to create a primer of QI in gastroenterology for the practicing clinician.

Methods

We performed a systematic review of QI literature in gastroenterology. We included search terms for inflammatory bowel disease, irritable bowel syndrome, celiac disease, gastroesophageal reflux disease, pancreatitis, liver disease, colorectal cancer screening, endoscopy, and gastrointestinal bleeding. We used general search terms for QI as well as specific terms to capture established quality metrics for each GI disease area.

Results

We found 33 studies that met our definitions for QI. There were 17 studies of endoscopy including screening colonoscopy, six on liver disease, four on IBD, two on GERD, three on GI bleeding, and one on celiac disease. Education was the most common intervention, although most successful studies combined education with another intervention. Other effective interventions included retraining sessions to reach ADR goals in colonoscopy, nursing protocols to increase HCC screening, and EMR decision support tools to prompt reassessment of PPI therapy. Many studies showed improved compliance to metrics, but few were able to show differences in length of stay, readmissions, or mortality.

Conclusions

Our review of quality improvement literature in gastroenterology revealed common themes of successful programs: Education was frequently used but often insufficient, the EMR may be underutilized in guiding decision making, and patient-reported outcomes were infrequently assessed. Further research may be needed to compare QI strategies directly.

Keywords

Quality improvement Health services Gastroenterology Delivery of health care 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Supplementary material

10620_2018_5198_MOESM1_ESM.docx (12 kb)
Supplementary material 1 (DOCX 12 kb)

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Courtney Reynolds
    • 1
  • Eric Esrailian
    • 1
    • 2
  • Daniel Hommes
    • 1
  1. 1.Division of Digestive Diseases, Department of MedicineUniversity of California Los AngelesLos AngelesUSA
  2. 2.Division of Digestive Diseases, Department of MedicineUniversity of California Los AngelesLos AngelesUSA

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